Burden of disease 2
Wednesday 8 October 2025, 11.00 – 12.30 Polar
Chairs: Tim Driscoll, Laura Salonen
Burden and distribution of psychosocial exposures in the USA workforce: the role of occupational segregation
Marissa Baker (presenter)
Trevor Peckham, Devan Hawkins, Shelley Stephan-Recaido
Abstract
Objective: Psychosocial work exposures contribute to leading causes of death and disability in the United States (USA). Disparities in the morbidity and mortality from these conditions have been consistently identified across sociodemographic strata. Here, we explore how occupational segregation, and exposure to work-related psychosocial hazards, could contributes to the uneven distribution of disease burden in the USA. Materials & Methods: We merged 2022 USA census data with occupational characteristic data from the Occupational Information Network (O*NET) to estimate the number and proportion of USA workers exposed to 19 psychosocial hazards in broad categories of job demand and control, social environment, and work schedule/wage. We estimated the number and proportion of USA workers over- or underrepresented in exposure burden by sociodemographic group (race, ethnicity, sex, educational attainment, nativity, age). Results: USA workers were most commonly employed in occupations with high time pressure (67.5 million USA workers; 43.2% workers), high emotional labor (57.1 million; 36.6%), and low wages (47.8 million; 30.6%). 49.4% of workers were employed in occupations with at least three psychosocial hazards. Exposures were uneven across sociodemographic strata, attributable to occupational segregation, with racial and ethnic minoritized workers, workers with less education, and foreign-born workers more likely to be employed in occupations with psychosocial hazards. Conclusions: Work-related psychosocial exposures are ubiquitous, and unevenly distributed. Given the high societal cost of work-related stress and the changing nature of work, work-related psychosocial hazards should be considered in occupational and public health research, policy, interventions, and surveillance. Findings show workplace factors influence the uneven distribution of chronic disease in the USA.
Co-exposure to occupational hazards and hypertension in petrochemical workers: risk assessment and mechanistic insights
Minhual LI (presenter)
Jianjun
Abstract
Background: Hypertension remains a major global public health challenge, with occupational environmental factors playing a significant role in its pathogenesis. Petrochemical workers chronically exposed to physical and chemical hazards demonstrate substantially higher hypertension risk than the general population. However, the combined effects and mechanistic pathways of occupational co-exposures on hypertension remain unclear. Dyslipidemia, as a critical risk factor, may mediate the association between occupational hazards and hypertension. Objective: To evaluate the impact of occupational co-exposure to hazardous factors on hypertension risk among petrochemical workers, and to explore the mediating role of dyslipidemia as well as co-exposure-related bioinformatic pathways. Methods: This cohort study analyzed 11,025 petrochemical workers in Quangang District, Fujian Province, China (2013-2022). We assessed exposure levels to physical (e.g., heat, noise) and chemical (e.g., CO, SO₂, benzene) hazards. Poisson regression and weighted quantile sum (WQS) regression evaluated exposure effects, while mediation analysis with E-value sensitivity testing examined dyslipidemia’s mediating role. Bioinformatics approaches identified co-exposure-related genes and protein pathways associated with hypertension. Results: Significant associations were observed between occupational hazards and hypertension risk, with evident interactions between physical and chemical factors. Co-exposure synergistically increased hypertension risk. Dyslipidemia mediated 4.17% of the co-exposure-hypertension association. Bioinformatics analysis identified 36 core genes linking occupational co-exposures to hypertension, primarily enriched in oxidative stress, inflammatory responses, and the renin-angiotensin system pathways. Conclusions: Occupational co-exposure to hazardous factors may synergistically increase hypertension risk among petrochemical workers, with dyslipidemia serving as a partial mediator. The underlying mechanisms of co-exposure effects potentially involve oxidative stress, inflammatory responses, and the renin-angiotensin system pathway.
Mortality and cancer incidence among wood workers in the Agrican cohort study.
Lucie de Graaf (presenter)
Pierre Lebailly, Isabelle Baldi
Abstract
Objective: Workers in the wood sector are directly and indirectly exposed to wood treatment products applied in forestry, sawmills, construction and trade. Some of them are banned and classified as carcinogens. However, literature on their exposure and health effects is scarce. The objective of this study is to analyze mortality by cause, prevalence of some non-cancer diseases and incidence of the main cancers among wood workers included in the Agrican cohort. Material & Methods: Within the Agrican cohort – that enrolled more than 181,000 workers affiliated to the health insurance for agriculture in 2005–2007 in 11 French areas –, a sub cohort of 9,125 workers involved in the wood sector was constituted and compared to farmers and non-agricultural workers. First, we described sociodemographic data, health characteristics and self-reported diseases. Then, we ran survival analyzes (Cox proportional hazard modes) on the main causes of death and cancer incidence from enrolment to the end of 2015. Results: Overall mortality in wood workers was comparable to that of farmers but was significantly lower than non-agricultural workers (n=922, HR=0.89 [0.81-0.98]). Overall cancer incidence (n=1,109) was similar to both groups. However, male wood workers had nonsignificant increased risks for: Hodgkin’s lymphoma (n=7; HR=2.24 [0.97-5.20]), bladder cancer (n=49, HR=1.26 [0.94-1.70]), skin melanoma (n=36, HR=1.25 [0.88-1.78]), pharyngeal cancer (n=40, HR=1.22 [0.88-1.70]) and lung cancer (n=104, HR=1.19 [0.97-1.46]). Women had higher risk of cancer of the ovary and the uterus (n=11 cases, HR=1.38 [0.76-2.51]) and kidney cancer (n=5, HR=2.14 [0.88-5.22]). Conclusion: The differences in cancer incidence between wood workers and farmers could suggest the impacts of occupational risks specific to this population. Additional research is needed to better characterize their occupational exposure.
Prevalence of self-reported skin symptoms among batik workers in Indonesia
Fandita Tonyka Maharani (presenter)
Andrew Povey, David Fishwick, Martie van Tongeren
Abstract
Objective: Batik, recognised by UNESCO as an Intangible Cultural Heritage, is produced using hazardous chemicals, exposing workers to potential health and safety risks. This study investigates the prevalence of self-reported skin symptoms among Indonesian batik workers. Material and methods: A cross-sectional study of batik workers (home-based and workshop-based) and batik sellers was undertaken in Central Java, Indonesia. Data on demographics, working conditions, and self-reported skin symptoms were collected using a questionnaire adapted from the Nordic Occupational Skin Questionnaire (NOSQ)-Short. Binary logistic regression analysed skin symptoms among workers. Results: This study recruited 276 batik workers (91 home-based, 90 workshop-based, and 95 sellers). Home-based batik workers were 100% female, workshop-based workers were 90% male and 10% female, and batik sellers were 10.5% male and 89.5% female. The mean age was 51 for home-based workers, 34 for workshop-based workers, and 43 for batik sellers. Among 46 participants with skin symptoms, 52.2% had at least one, 41.3% had two, and 6.5% had three. Hand eczema prevalence among home-based, workshop-based, and batik sellers was 19.8%, 20%, and 1.1%, respectively. Wrist/forearm eczema prevalence was 12.1%, 17.8%, and 0%, while atopic dermatitis-like symptoms were 1.1%, 4.4%, and 2.1%. After adjusting for confounders (age, BMI, smoking, education, and work experience), home-based batik workers were 11 times more likely to develop skin symptoms than sellers (95% CI: 2.6-47.4). The workshop-based batik workers were 6 times more likely to develop skin symptoms than batik sellers (95%CI: 1.4-26.8). Conclusion: Skin symptoms are common among batik workers, particularly home-based ones, highlighting the need for intervention to minimise health risks. Acknowledgement: This study is funded by LPDP RI (Indonesian Endowment Fund for Education) and Ministry of Higher Education, Science, and Technology of Republic Indonesia.
Sickness absences due to mental disorders and disability pension risk in Finland
Riku Perhoniemi (presenter)
Jenni Blomgren
Abstract
Objective There has been an increase in mental disorders in OECD countries in recent years. Mental disorders are also often behind sickness absences (SA) and disability pensions (DP). Exacerbated by the Covid-19 pandemic, especially high rates of depression, and anxiety have been reported. Comparison between different types of mental disorders causing SA as risk factors for a prospective DP transition has seldomly been examined with appropriate study settings. An updated view on this association, adjusting for various other risk-inducing factors, is thus needed. Material and Methods Our study sample included non-retired Finns with a long-term sickness absence based on a mental disorder starting in 2020. Sickness absence was measured through sickness allowance days accumulated over a 12-month period. After this period, each person was followed for 36 months for transitions to DP (the dependent variable). A variable distinguishing between different mental disorders as bases for SA was used as the main independent variable. The risk of entering into DP was examined using descriptive methods and survival analysis (Cox proportional hazards regression). Results Cox proportional hazards regression analyses showed substantial differences in the hazard ratios for prospective DP risk across different mental disorders, even when adjusting for various covariates and the total length of SA influencing the DP risk. Psychoses had the highest hazard ratios, and psychiatric sleep disorders the lowest ones. Conclusion Different mental disorders as bases for sickness absences pose differing risks for permanent work disability. It is important to recognize that different mental disorders contribute to the total disability burden in differing ways – some cause a great amount of sickness absence days but few DP transitions, while some in particularly increase the risk of permanent work disability.
Social variance in cancer incidence, results from the new Nordic occupational cancer study
Jan Ivar Martinsen (presenter)
Sanna Heikkinen, Johnni Hansen, Elsebeth Lynge, Jóhanna Eyrún Torfadóttir, Ingrid Sivesind Mehlum, Jenny Selander, Marcin W. Wojewodzic, Eero Pukkala,
Abstract
Objective: The updated Nordic Occupational Cancer Study (NOCCA) includes birth cohorts from 1896 to 1980, adds new job categories, and provides 60 years of follow-up from 1961 to 2020. Based on data from 22 million individuals and 4.5 million cancer cases across the Nordic countries, the study offers a unique opportunity to examine both rare and common cancers across a large population. For example, it includes 4,000 cases of mycosis fungoides, and 440,000 cases of lung cancer. The 60 occupational categories can be classified by socioeconomic position (SEP), a key determinant of cancer burden. Individuals in lower SEP-groups have higher rates of smoking-related cancers, while higher SEP-groups show increased incidence of breast, colon, and skin cancers. This presentation highlights breast cancer in women, colon cancer in men, and melanoma in both sexes to illustrate SEP-related disparities. Methods and analysis: By combining occupational history with long-term cancer registry data, NOCCA allows for the assessment of cancer risk across specific socioeconomic and occupational groups, including trends over time and between countries. The standardized incidence ratio (SIR), calculated as the ratio of observed to expected cancer cases using rates from the Nordic populations, was estimated. Results: SIR for breast cancer ranges from 0.89 in the lowest SEP-group to 1.15 in the highest. For colon cancer, the SIR varies from 1.00 to 1.07. In contrast, melanoma shows a wider range, with SIRs spanning from 0.81 to 1.28. Conclusion: Breast cancer risk increases with socioeconomic position, likely influenced by lifestyle and reproductive factors. Colon cancer shows only a modest variation by SEP, though it may be associated with sedentary occupations. Melanoma presents the strongest SEP gradient, with higher incidence in more advantaged groups, potentially reflecting greater UV exposure. These patterns reveal how socioeconomic factors contribute to variations in cancer risk.